Medicare Part B: therapeutic shoe coverage
About one in four individuals with diabetes develop foot problems as a result of the disease. Poor circulation and neuropathy (nerve damage leading to a lack of sensation) can lead to serious foot problems such as ulcers and infection. To help people care for their feet, Medicare Part B offers coverage for therapeutic shoes.
What is the Medicare Part B therapeutic footwear benefit?
Medicare Part B partially covers the approved cost of medically-necessary shoes or inserts. Patients may qualify for one of the following benefits:
- One pair of depth-inlay shoes and three pairs of inserts
- One pair of custom-molded shoes, including inserts, and two additional inserts for patients who cannot wear depth-inlay shoes due to a foot deformity
- Separate inserts or shoe modifications for some patients with milder foot problems
Medicare pays 80 percent of the approved cost for footwear and the full cost of fitting the shoes. Qualifying patients are eligible for one pair of therapeutic shoes or inserts per year. The patient is responsible for the remaining 20 percent of the cost as well as any applicable deductible.
Medicare does not cover the cost of deluxe features such as a custom style, material or color.
How to qualify for therapeutic footwear coverage
To qualify for the therapeutic footwear benefit, patients must meet three conditions:
- Have type 1 or type 2 diabetes
- Have a diabetes-related foot conditions from the following list: Partial or complete amputation, past foot ulcers, calluses that could lead to ulcers, nerve damage, poor circulation or a deformed foot
- Be involved in a comprehensive diabetes care plan
A doctor must fill out a certificate of medical necessity verifying the patient meets the above criteria and write a prescription specifying the type of footwear the patient needs. Finally, Medicare requires that a physician or podiatry specialist -- pedorthist, orthotist or prosthetist -- provide and fit the shoes for the patient, including any custom preparation work. To ensure Medicare coverage, it's important to source the footwear from a Medicare-approved supplier.